double-checking insulin with cokworker

[bth44]

Does anyone here work at a hospital where there is not a policy r/t double-checking insulin? I know that there are some places where it's not policy, but the nurses do it anyway because of safety. I graduated last June and was hired with some other people from my class at the local hospital. Policy at our hospital is that insulin is to be double-checked by two RN's. Sometimes, doing the double-check feels like like a pain but I feel it's always better to be safe than sorry.

Well, I was hired to a med/surg unit with fellow new grad who I went to nursing school with. He's always been a cocky, confident, know-it-all individual, and it continues here at work on the floor. Whenever I ask him to check my insulin with me, he won't even look at the syringe that I've just drawn up, but he'll say, "Looks good" then walks off. If he's in the medication room getting his insulin ready while I'm in there, I'll offer to check it with him. He'll say, "I guess, if you want to", and that tells me he was planning to give the insulin without a double check. I've confronted him about it and he told me that double-checking insulin is "lame". He said that insulin is just like the meds we draw up for IV pushes, and we don't double-check those, so he feels that double checking insulin is a waste of time and he said he's skeptical about an extra unit or two of insulin causing real harm to the patient. I'm one of those "go-by-the-book" type of people, especially when I'm in "nurse-mode". I'm not a timid or nervous nurse, but I feel that if I follow the policy of the hospital and try my best, then the chances of something bad happening diminish greatly. I expect myself to do a good, safe job at work, and I expect the same from the team I work on. I feel that he's cutting corners and he's being a lazy. He just applied for a charge position on our unit, and he got it. I find that really scary, and I'm seriously considering applying for a postion on a different shift, because I don't think I could work under a charge nurse that I don't trust or respect as a safe practictioner.

So, all you more-experience nurses out there: Can getting an extra units of insulin be critical? Personally, I definitely think so. I also feel that giving the wrong type of insulin by accident because you didn't double check can also be big trouble. Or do I just sound like a fussy nurse?

How do you feel about my coworker's attitude? I'm afraid that this attitude of his is going to get him in a lot of trouble later. If you were in position, would you address any of this to the unit manager? How would you go about doing it? Remember, he just was granted a charge nurse postion, so I'm pretty sure the unit manager thinks highly of him.

[suzanne4, RN]

Required where I work now and the last two places. The MAR actually has to have a second nurse signature............

[lisamc1RN, LPN]

Recently at one of our clinical facilities, a seasoned nurse made a huge mistake. She drew up THREE insulin syringes and administered them to her patient. She misread the doctors orders. The patient nearly died. The hospital had to run glucose on her all night. Our instructor said that the nurse got distracted by other residents and aides, people asking her questions, etc. She didn't follow the policy of going into the med room to draw up the insulin and she didn't get it double checked. She lost her job. It sticks in my mind and reminds me that no matter how much experience I get, I will always be a fallible human being, so I'd better always practice safety and follow policy! It sounds like this guy has yet to realize this. He's only human, and humans make mistakes.

[nursenatalie, ADN, RN]

Was the instructor drawing up regular insulin and lantus? There are times when you have to give two sticks

[CoffeeRTC, BSN, RN]

In LTC it would be very difficult to get a second check. Many times you are the only nurse on your floor or unit..I have 8 diabetics on my hall now so leaving the floor isn't an option. If another nurse is handy I do try to get one to go over meds that I havent given in a while.

[unknown99, BSN, RN]

We only double check insulin if it is IV insulin.

[stevierae]

The only way it was discovered was that another nurse was looking for an insulin syringe and the LPN said, there are syringes there, well, they were tb syringes.

I always double check my insulin and heparin with another RN (or an anesthesiologist.) It's simply safer, and what I was taught that a reasonable and prudent health care provider DOES. That's how I trained as a corpsman in the Navy 30 years ago, and that's how I've always done it. We were taught that was standard of care (although we didn't know that term yet, LOL!) when I went to nursing school, as well--graduated in '81.

That said, let me correct a common misconception that younger RNs seem to have. THERE REALLY ISN'T ANYTHING WRONG WITH GIVING INSULIN WITH A TB SYRINGE.

If you know your pharmaceutical math, and can calculate properly, there's really no reason you couldn't, in a pinch, give insulin in a TB or even a 3cc syringe---it's just far more convenient to draw it up in an Insulin syringe, since the Units are right there on the syringe. You just have to do your Units to ml. conversion correctly to use another type of syringe.

If 1 cc. = 100 Units, then 0.75 cc= 75 Units, 0.5 cc. = 50 Units, and 0.25cc=25 Units, correct? The other increments on a TB syringe--0.1, 0.2, 0.3 cc correspond to 10, 20 and 30 Units of U-100 Insulin, the only kind made these days. Still, even though you can do this simple math in your head, it's prudent to double check it on paper.

There is absolutely nothing special about an insulin syringe other than its Unit (U) markings. If you turn it to the side, you see the corresponding calibrations in ml (cc.) An insulin syringe is virtually identical to a TB syringe---1 cc. is still 1 cc; 0.5 cc. is still 0.5 cc, etc. It simply has Unit markings as well as ml. markings on it, for convenience.

Granted, you will probably never be in the position where you have to use a TB syringe instead of an insulin syringe in the hospital--both are in plentiful supply--but if you ever work home health or an inner city clinic (or in a third world country) a TB syringe or 3cc. syringe may be all you have. Just do your math, convert your Units to ml. and everything will be just fine.

I am really dating myself, but you guys are really fortunate that the ONLY insulin syringes you have these days are U-100. We used to have U-30 (or maybe it was U-40; can't recall for sure) and U-80 syringes, and sometimes THOSE were in short supply. We did our pharmaceutical math, converted U to ml., and administered the dose via whatever syringe we had---and this was in the days before calculators.

Don't forget that a big part of nursing is critical thinking, and that means thinking outside of the box, occasionally. I have actually heard stories of home care patients going without their insulin because the inexperienced home care nurse forgot to pack insulin syringes in her bag before setting out, and it didn't occur to her (or her pharmaceutical math skills were lacking) that she could use a TB or other type of syringe--say, a 3cc.-- (in plentiful supply in her bag) and ensure continuity of safe patient care.

Oh, and by the same token----no reason why one can't use an insulin syringe to give Heparin, either. JUST DO YOUR MATH or THINK about what you are doing. If you need to give 1000 U of Heparin, and you have a vial of Heparin that is 1000 U/cc, but no TB syringes, what do you do? You take an Insulin syringe and draw up your Heparin to the U-100 mark--which is 1 cc!!!

To validate this, do your math, or simply turn your Insulin syringe to the side--you should see the 1 ml. mark correspondin gto the U-100 mark.

Have to give 100 U Heparin in an insulin syringe? Do your math, at the same time realizing that if 1000 U Heparin=1cc, or, on an insulin syringe, U-100; then 750 U of Heparin must equal 0.75 cc, or, on an insulin syringe, U-75; 500 U of Heparin must equal 0.5 cc, or, on an insulin syringe, U-50--all the way up to your desired dose, 100 U of Heparin, which is 0.1 cc, or, on an insulin syringe, U-10. Simple common sense and easy math to double check on paper.

[barefootlady, ADN, RN]

Thanks for the review stevie.

[Mulan]

I always double check my insulin and heparin with another RN (or an anesthesiologist.) It's simply safer, and what I was taught that a reasonable and prudent health care provider DOES. That's how I trained as a corpsman in the Navy 30 years ago, and that's how I've always done it. We were taught that was standard of care (although we didn't know that term yet, LOL!) when I went to nursing school, as well--graduated in '81.

That said, let me correct a common misconception that younger RNs seem to have. THERE REALLY ISN'T ANYTHING WRONG WITH GIVING INSULIN WITH A TB SYRINGE.

If you know your pharmaceutical math, and can calculate properly, there's really no reason you couldn't, in a pinch, give insulin in a TB or even a 3cc syringe---it's just far more convenient to draw it up in an Insulin syringe, since the Units are right there on the syringe. You just have to do your Units to ml. conversion correctly to use another type of syringe.

If 1 cc. = 100 Units, then 0.75 cc= 75 Units, 0.5 cc. = 50 Units, and 0.25cc=25 Units, correct? The other increments on a TB syringe--0.1, 0.2, 0.3 cc correspond to 10, 20 and 30 Units of U-100 Insulin, the only kind made these days. Still, even though you can do this simple math in your head, it's prudent to double check it on paper.

There is absolutely nothing special about an insulin syringe other than its Unit (U) markings. If you turn it to the side, you see the corresponding calibrations in ml (cc.) An insulin syringe is virtually identical to a TB syringe---1 cc. is still 1 cc; 0.5 cc. is still 0.5 cc, etc. It simply has Unit markings as well as ml. markings on it, for convenience.

Granted, you will probably never be in the position where you have to use a TB syringe instead of an insulin syringe in the hospital--both are in plentiful supply--but if you ever work home health or an inner city clinic (or in a third world country) a TB syringe or 3cc. syringe may be all you have. Just do your math, convert your Units to ml. and everything will be just fine.

I am really dating myself, but you guys are really fortunate that the ONLY insulin syringes you have these days are U-100. We used to have U-30 (or maybe it was U-40; can't recall for sure) and U-80 syringes, and sometimes THOSE were in short supply. We did our pharmaceutical math, converted U to ml., and administered the dose via whatever syringe we had---and this was in the days before calculators.

Don't forget that a big part of nursing is critical thinking, and that means thinking outside of the box, occasionally. I have actually heard stories of home care patients going without their insulin because the inexperienced home care nurse forgot to pack insulin syringes in her bag before setting out, and it didn't occur to her (or her pharmaceutical math skills were lacking) that she could use a TB or other type of syringe--say, a 3cc.-- (in plentiful supply in her bag) and ensure continuity of safe patient care.

Oh, and by the same token----no reason why one can't use an insulin syringe to give Heparin, either. JUST DO YOUR MATH or THINK about what you are doing. If you need to give 1000 U of Heparin, and you have a vial of Heparin that is 1000 U/cc, but no TB syringes, what do you do? You take an Insulin syringe and draw up your Heparin to the U-100 mark--which is 1 cc!!!

To validate this, do your math, or simply turn your Insulin syringe to the side--you should see the 1 ml. mark correspondin gto the U-100 mark.

Have to give 100 U Heparin in an insulin syringe? Do your math, at the same time realizing that if 1000 U Heparin=1cc, or, on an insulin syringe, U-100; then 750 U of Heparin must equal 0.75 cc, or, on an insulin syringe, U-75; 500 U of Heparin must equal 0.5 cc, or, on an insulin syringe, U-50--all the way up to your desired dose, 100 U of Heparin, which is 0.1 cc, or, on an insulin syringe, U-10. Simple common sense and easy math to double check on paper.

That's fine if they make the conversion, unfortunately those nurses didn't and gave overdoses.

[minnib]

Hi All,

Even if the hospital did not have a policy I WOULD STILL ask a nurse to double check with me. Tell that @$^%*@! nurse yeah 1 or 2 units off if you are lucky on that one mistake but what happens when even if you do all of the checks for some reason( horrible shift, migraine headache, etc) the order calls for 2 units and you give 20?!!!! Ask him what then?.....and this does happen!, even to really good, careful nurses. So ask him how he would feel if he ever brought harm to a pt all by simply not doing a 2 nurse check.

juz my 2cents!

minnib

[LPN1974, LPN]

If I worked in a hospital I would want to have another nurse check my insulin, but in the setting I work in now, it's impossible to have another nurse check.

I work in MR/DDS, we go to 8 separate homes to give meds. So I am in one part of the campus, and my co-worker is in another.

There are a few safeguards tho. In this setting we only have U-100 insulin syringes available....no TB syringes to get mixed up with them, and the insulin is exactly what is ordered for the resident. No other kinds there to get mixed up with his/hers.

But I STILL read my cards and labels 3 times during the setup, just to be extra careful.

Dosages can change at any time.

But where I work we're on our own...no second nurse to check.

[stevierae]

That's fine if they make the conversion, unfortunately those nurses didn't and gave overdoses.

One more reason to double check with another nurse.

I agree with LPN1974---in situations such as LTC, or MR/DDS, where there ISN'T another nurse to double check with, it's probably much more prudent to have ONLY insulin syringes on hand, to cut down on the inevitable errors that can occur when one is rushed, overworked, fatigued, or the victim of nurse understaffing.

[CapeCodMermaid, RN]

Have been a nurse since 1982. I was taught to always have 2 nurses check insulin (and heparin) doses, and I have done that ever since.